Intramedullary cervical abscess in the setting of aortic valve endocarditis

Abstract

Spinal cord tissue has a remarkable resistance to infection. An intramedullary abscess is an exceptional complication of infective endocarditis in the post-antibiotic era. We describe the case of a 42-year-old man who presented with fever and cephalea. Two days later, left-side numbness, lack of sphincter control, and a new aortic murmur were noticed. Magnetic resonance imaging demonstrated an 8 ×15-mm intramedullary cervical abscess. Transesophageal echocardiography revealed an aortic valve perforation as a result of infective endocarditis. Conservative management was decided for the intramedullary abscess.

Cervical Epidural Abscess: Rare Complication of Bacterial Endocarditis with Streptococcus Viridans: A Case Report

“…As was observed in our case, cervical abscess could be originate from embolic involvement of aortic valve endocarditis by hematogenous spread 3) . However, IE can develop without a valve anomaly.…”

“…Conservative management of epidural abscess is reserved for patients with poor surgical risk or patients without any neurological deficit 2) . The association between spinal epidural abscess and infective endocarditis (IE) has rarely been described 3) . In fact, only eleven cases of vertebral osteomyelitis complicating streptococcus viridans endocarditis have been previously reported, and of these, only three were located in the cervical spine.…”

Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

“…Intramedullary infections can be precipitated by several risk factors, including dermoid cysts [18]. intravenous drug use [6], genitourinary infections [1], osteomyelitis [19], penetrating or iatrogenic injuries to the spine [20], endocarditis [2], septic embolism [7], bacterial meningitis [8], and pre-existing spinal pathologies, including spinal tumors, AVMs or dural arteriovenous fistulas [21,22]. Of note, the patients reported here did not appear to have any of these predisposing conditions.…”

“…Having a high index of suspicion is essential for prompt diagnosis and effective clinical management. While intramedullary abscesses are thought to result from the secondary spread of an ongoing infection, often no other primary source of infection can be found [1][2][3][4][5][6][7][8]. Many organisms have been associated with intramedullary abscesses, including Mycobacterium tuberculosis in the developing world and gram-positive cocci-i.e., primarily oral or skin flora-in the developed world [9][10][11].…”

Streptococcus pneumoniae meningitis complicated by an intramedullary abscess: a case report and review of the literature

“…This suggests that residual tissue damage caused by radiotherapy may have predisposed the patient to the formation of the intramedullary abscess. In another case, a previously healthy patient presented with infective endocarditis of the aortic valve and was later found to have an 8 × 15-mm intramedullary abscess in the cervical spinal cord [ 3 ].…”